Understanding Atrial Fibrillation With Rapid Ventricular Rate
Atrial fibrillation (AFib) is the most frequent human heart arrhythmia and increases in prevalence as we age. People over the age of 65 have an almost fivefold increase in the occurrence of AFib than those under 65.
AFib causes the heart’s upper chambers, called the atria, to contract at irregular intervals because they receive irregular electrical impulses instead of the normal synchronized ones.
In some cases, the transmission of a high percentage of these impulses to the ventricles causes them to beat out of control at speeds faster than 100 bpm, creating a situation called a rapid ventricular response (RVR).
For people who have AFib with RVR, it’s vital to seek medical treatment immediately to slow the rhythm down and prevent the possibility of severe complications.
Differences Between Controlled AFib Versus AFib With RVR
Controlled AFib is different from AFib with RVR because of the differences in heart rate. Individuals with controlled AFib have heart rates that range from 60 to 100 beats per minute.
People with the RVR type of AFib often experience heart rates of 150 to 220 beats per minute. The accelerated heart rate causes an increased demand on the heart muscle and also produces instability in a person’s blood pressure response.
Categories of AFib With RVR
Much like controlled AFib, AFib with RVR falls into different classes according to how long the disorder lasts. The groups of AFib with RVR are:
- Paroxysmal, indicating that the problem comes and goes without warning. Paroxysmal AFib with RVR can last minutes to hours and can resolve on its own without medical treatment.
- Persistent, which means that the condition will not return to normal unless there is some medical intervention.
- Long-standing persistent, which lasts at least one year.
- Permanent, meaning that the heart rhythm is unable to return to normal and requires medication, an implanted device such as a pacemaker, or a surgical procedure to regulate the heart rate.
Symptoms of AFib With RVR
If you have AFib with RVR, chances are you have experienced one or more of the following symptoms:
- Dizziness or feeling faint
- Feeling like your heart is fluttering
- Inability to tolerate physical activity
- Pressure or tightness in your neck
- Tightness or pounding in your chest
- Shortness of breath
- Weakness or loss of energy
In some cases, like in controlled AFib, AFib with RVR presents with no symptoms and is only detected with an EKG or another diagnostic tool.
Many people report that the symptoms they have with episodes of AFib with RVR are much more uncomfortable than those associated with controlled AFib.
If these symptoms happen, it’s important to seek medical attention early so that your heart rate regains control before more problems occur.
The Dangers of AFib with RVR
In AFib with RVR, the lower chambers of the heart, called the ventricles, are unable to move enough blood out to the lungs and the rest of the body because they fail to fill completely.
AFib with RVR is not fatal, but if it isn’t addressed, over time, the situation will lead to the start of congestive heart failure.
Congestive heart failure is a higher risk for people that have AFib with RVR if they have another type of heart condition. If you already have congestive heart failure, AFib with RVR can make the problem worse.
People that have AFib with RVR are also at a higher risk for stroke because of the increased chance for blood clot formation. AFib coupled with RVR can also lead to cardiogenic shock, which happens due to a decrease in the heart’s output and reduces oxygen flow to muscles and other tissues.
AFib with RVR is more severe than other types of AFib and requires that you seek swift medical attention.
Diagnosis of AFib With RVR
Your physician will diagnose AFib with RVR using several different methods that include:
- A chest x-ray scheduled to check whether other heart or lung conditions are present and causing or contributing to the problem.
- An EKG reading performed in the emergency room or the outpatient clinic.
- Blood tests are often used to rule out the possibility of other issues that can cause related problems.
- Prescribing a Holter monitor, which is a wearable portable device that tracks and records your heart rhythm for a 24-hour period.
- Ordering an event recorder, which is like a Holter monitor but tracks the heart rate and rhythm for as long as one If the individual has symptoms, they are to activate the device.
- A stress test that monitors your heart rate and rhythm during exercise can detect other issues contributing to AFib.
- An echocardiogram helps to determine your heart muscle’s pumping capacity, and will also show if any blood clots have developed because of your AFib.
If your test results show you have AFib with RVR, your physician will design an individualized plan of care to meet your needs.
Atrial Fibrillation With Rapid Ventricular Response Treatment
The primary treatment goal for RVR in AFib is to decrease the heart rate. Medications are the first choice to control and convert AFib back to normal. If drugs don’t work for you, electrical cardioversion is the second step.
An implantable device such as a pacemaker is often a good choice In instances of long-standing AFib with a fluctuating rate. In some cases, a cardiac ablation is also a viable option.
Medications Used for AFib With RVR
The primary class of drugs used for rate control is beta-blockers, which slow the heart rate quickly and reduce symptoms. Propranolol and esmolol are two of the most often used beta-blockers for AFib.
A secondary class of medications, known as calcium channel blockers, also function to decrease heart rate. Diltiazem and verapamil are two frequently prescribed choices.
A separate group of medications known as antiarrhythmics, or rhythm control drugs, are strong acting and designed to convert AFib back to a normal rhythm. Examples of antiarrhythmics are amiodarone, flecainide, procainamide, and sotalol.
Some of these AFib medications will require you to take them on a long-term basis.
Next page: More treatments of AFib with RVR, and Jeff’s experience with the condition.